Initial and Sustained Attentional Bias Toward Emotional Faces in Patients with Major Depressive Disorder

Major depressive disorder (MDD) represents a prevalent mental health condition characterized by prominent attentional biases, particularly toward negative stimuli. While extensive research has established the significance of negative attentional bias in depression, critical gaps remain in understanding the temporal dynamics and valence-specificity of these biases. This study employed eye-tracking technology to systematically examine the attentional processing of emotional faces (happy, fearful, sad) in MDD patients (n = 61) versus healthy controls (HC, n = 47), assessing both the initial orientation (initial gaze preference) and sustained attention (first dwell time). Key findings revealed the following: (1) while both groups showed an initial vigilance toward threatening faces (fearful/sad), only MDD patients displayed an additional attentional capture by happy faces; (2) a significant emotion main effect (F (2, 216) = 10.19, p < 0.001) indicated a stronger initial orientation to fearful versus happy faces, with Bayesian analyses (BF < 0.3) confirming the absence of group differences; and (3) no group disparities emerged in sustained attentional maintenance (all ps > 0.05). These results challenge conventional negativity-focused models by demonstrating valence-specific early-stage abnormalities in MDD, suggesting that depressive attentional dysfunction may be most pronounced during initial automatic processing rather than later strategic stages. The findings advance the theoretical understanding of attentional bias in depression while highlighting the need for stage-specific intervention approaches.